Vacuum-assisted Wound Closure System Research Articles

Local device infection successfully treated without pacemaker removal in a neonate: a case report

Local device infection is a serious complication, especially in neonates. Complete device removal is the gold standard treatment for cardiac device infection; however, in selected cases alternative strategies could be adopted. We describe a case of a 14-day-old neonate, weighing 2.5kg, who had undergone epicardial double chamber pacemaker implantation for a congenital complete atrioventricular block. The generator pocket was created in the epigastric area below the rectus abdominis. At six days after implantation, pocket infection was found; blood cultures and the transoesophageal echocardiogram were normal. Due to the low weight of the neonate, and the limited possibility of finding a new comfortable site for housing the generator far from the infected area, we opted for a conservative strategy. We successfully applied a combination of antibiotic therapy, a vacuum-assisted wound closure system (KCI, Germany) for 40 days, and then skin transfer flap from the right flank without device removal. At one-year follow-up there were no local or systemic signs of infection.

In selected foot injuries, can the amputation level be changed with vacuum assisted wound closure system treatment? : a case report

Foot injuries are frequently seen injury types. Upper and lower extremity injuries with soft tissue defects have a long and difficult treatment period. Early revascularisation is very important in such situations but is not always possible in every case and under all conditions. The case is here presented showing recovery in a different manner to that predicted. The patient had an injury which seemed to require amputation, and with the vacuum assisted wound closure system, grafting was applied to the wound, then with an appropriate orthosis and rehabilitation, successful preservation of the extremity was completed.

Aplicación del sistema de presión negativa VAC® en dehiscencia postesternotomía media en pacientes neonatos

Vacuum-assisted wound closure system (VAC®) hasconsolidated as an important tool for the management ofpost-sternotomy mediastinitis in neonates. Its use has ...

Bilateral necrotizing fasciitis of the breast following quadrantectomy

Necrotizing fasciitis (NF) is a rare and highly lethal soft-tissue infection that involves the skin, subcutaneous tissue, and fascia. Although it can affect any part of the body, the breast is seldom involved. We describe a case of bilateral NF of the breast following elective quadrantectomy, successfully treated with antibiotics, bilateral mastectomy, and a vacuum-assisted wound closure system.

Management of Deep Wound Complications With Vacuum‐Assisted Therapy After Berlin Heart EXCOR Ventricular Assist Device Placement in the Pediatric Population

Wound complications after ventricular assist device (VAD) placement remain a formidable challenge to surgeons. The Berlin Heart EXCOR VAD is a versatile pulsatile system that has been successful in pediatric patients of all ages and sizes. Prevention of device-related complications such as infection, particularly in pediatric patients, remains an essential issue in minimizing patient morbidity and mortality. The introduction of vacuum-assisted wound closure (VAC) therapy and its application in VAD-related wound complications provide an efficient and effective method for wound healing. We report our experience in the management of deep wound complications in two pediatric patients after placement of the Berlin Heart EXCOR VAD. The wound VAC system proved to achieve complete wound healing without any infectious complications.

Therapy of Spinal Wound Infections Using Vacuum-assisted Wound Closure: Risk Factors Leading to Resistance to Treatment

This study retrospectively reviewed spine surgical procedures complicated by wound infection and managed by a protocol including the use of vacuum-assisted wound closure (VAC). To define factors influencing the number of debridements needed before the final wound closure by applying VAC for patients with postoperative spinal wound infections. VAC has been suggested as a safe and probably effective method for the treatment of spinal wound infections. The risk factors for infection resistance and need for debridement revisions after VAC placement are unknown. Seventy-three consecutive patients with 79 wound infections after undergoing spine surgery were studied (6 of them had recurrence of infection). All patients were taken to the operating room for irrigation and debridement under general anesthesia followed by placement of the VAC with subsequent delayed closure of the wound. Linear regression and t test were used to identify if the following variables were risk factors for the resistance of infection to VAC treatment: timing of clinical appearance of infection, depth of infection (deep or superficial), presence of instrumentation, positive culture for methicillin-resistant Staphylococcus aureus (MRSA) or more than 1 microorganism, age of the patient, and presence of other comorbidities. There were 34 males and 39 females with an average age of 58.4 years (21 to 82). Once the VAC was initiated, there was an average of 1.4 procedures until and including closure of the wound. The wound was closed an average of 7 days (range 5 to 14) after the placement of the initial VAC on the wound. The average follow-up was 14 months (range 12 to 28). All of the patients but 2 achieved a clean, closed wound without removal of instrumentation at a minimum follow-up of 1 year. Sixty patients had implants (instrumentation or allograft) within the site of wound infection. Thirteen patients had a decompression with exposed dura. Sixty-four infections (81%) presented with a draining wound within the first 6 weeks postoperatively. Sixty-nine infections (87.3%) were deep below the fascia. There was no statistical significance (P>0.05) of all tested risk factors for the resistance of infection to treatment with the VAC system. The parameter more related to repeat VAC procedures was the culture of MRSA or multiple bacteria. VAC therapy may be an effective adjunct in closing spinal wounds even after the repeat procedures. The MRSA or multibacterial infections seem to be most likely to need repeat debridements and VAC treatment before final wound closure.

Vacuum-assisted wound closure of deep infections after instrumented spinal fusion in six children with neuromuscular scoliosis

Background context The rate of infection after spinal fusion in neuromuscular scoliosis is reported to range from 4% to 20%. Infection persists in about 50% after traditional treatment including debridement and closure. Instrumentation removal is necessary in up to 28%. Purpose To analyze the outcome of vacuum-assisted wound closure (VAC) in combination with antibiotics for the treatment of deep wound infection after instrumented spinal fusion in pediatric neuromuscular scoliosis. Study design Six prospective consecutive neuromuscular patients with scoliosis. Patient sample Between 2001 and 2005, six consecutive pediatric patients (average age, 12.6 years) with neuromuscular scoliosis with a postoperative deep wound infection after instrumented spinal fusion were included in the study. Outcome measures Measurement of the duration of wound closure and infection parameters during treatment. Methods The patients were treated with a VAC system in combination with antibiotics. Results Wound closure averaged 3 months. Infection parameters were normalized within 6 weeks. Removal of the instrumentation was not necessary in any patient, and there were no signs of infection at follow-up ranging from 9 to 42 months. Conclusion The VAC system, in combination with antibiotic therapy, seems to be a useful method for treatment of deep wound infections after spinal fusion in pediatric neuromuscular scoliosis. It may prevent removal of the instrumentation and multiple surgery for irrigation and closure of the wound.

Life-Threatening Intratumor Hemorrhage in Plexiform Neurofibroma: A Case Report and Literatures Review

Plexiform neurofibromas is a common feature of neurofibromatosis 1 (NF1). This benign soft tissue tumor can cause different kinds of complications, depend on their size and location. Some of the complications demand prompt and aggressive surgical intervention, such as massive intratumor hemorrhage, which is potentially life-threatening if not treated adequately and can result in hypovolemic shock or compression of vital structures. We report a case of trunk plexiform neurofibromas with spontaneous massive intratumor hemorrhage, which could not be controlled under conservative management and resulted in chest wall compression, respiratory insufficiency as well as hypovolemic shock 18 hours after the episode. Urgent surgical intervention was performed and totally 6,000 ml blood clot and hematoma were evacuated from the tumor. He received angiography and selective embolization as an adjuvant therapy for further hemostasis. A huge skin defect developed over the fragile and myxomatous tumor-tissue secondary to ischemic change, which was successfully treated by vacuum-assisted wound closure system (VAC) followed by skin graft. The patient was doing well at 1-year follow-up.

Vacuum-assisted Wound Closure after Resection of Musculoskeletal Tumors

Resection of musculoskeletal tumors may result in large soft tissue defects that cannot be closed primarily and require prolonged dressing changes and complex surgical interventions for wound coverage. We retrospectively reviewed 23 patients with such defects treated with a vacuum-assisted wound closure system and compared the outcome of these patients with a control group. The study group included 15 women and eight men who had their wounds located at the back (two), pelvic girdle (11), thigh (eight), and leg (two). Treatment included sealed wound coverage with polyurethane foam and overlying tape connected to a vacuum pump. This system was disconnected and changed every 48 hours for 7 to 19 days, after which all defects were reduced in size by an average of 25% and covered with a viable granulation tissue. This allowed primary closure in seven patients, primary closure with skin grafting in 14 patients, and healing by secondary intention in two patients. Compared with the control group, patients in the study group had shorter hospital stays and number of surgical interventions and greater rates of primary wound closure. The use of vacuum-assisted wound closure facilitates wound healing and primary wound closure in patients who have a large soft tissue defect after resection of a musculoskeletal tumor. Therapeutic study, Level III (retrospective comparative study). See the Guidelines for Authors for a complete description of levels of evidence.

Negative pressure dressings as an alternative technique for the treatment of infected wounds.

Coverage of wounds caused by infection and subsequent treatment often are variable because of the location of the wound and wound size. Although much research has been done to expand the indications of negative pressure wound treatment systems, little investigation has been done to quantify the reduction of wound size for vacuum-assisted closure treatment in the presence of infection. In this series, 14 patients who had wounds caused by infections were treated with the vacuum-assisted wound closure system. All wounds were greater than 20 cm2. The duration of treatment averaged 10 days (range, 2-27 days), and the initial wound size averaged 70 cm2 (range, 22.5-288 cm2). After the course of treatment, the final wound size averaged 39 cm2 (range, 10-147 cm2). The average wound size reduction was 43%. This method seems to enhance the rapidity of wound reduction, and because it is a closed system of treatment, it has the added benefit of minimizing exposure of staff and other patients to communicable diseases. Vacuum-assisted wound closure systems add another option in the care of musculoskeletal infections.